This prospective study used arthroscopy within 72 hours to look inside the shoulder after a first-time anterior dislocation. It asked how often a Hill-Sachs lesion is actually present after a single dislocation. All 32 patients were young military members or their families with no prior shoulder injury.
The key teaching point: a Hill-Sachs lesion is not proof of recurrent instability. It is present in nearly half of first-time dislocators. When you see a Hill-Sachs lesion on imaging after a single dislocation, do not over-read it as chronic disease. It is an expected impaction fracture from the posterolateral head hitting the glenoid rim.
The clinically important lesion driving instability is the accompanying Bankart tear, which coexisted in 87% here and cannot be seen on plain films. Diagnosis depends on getting the right views. Standard AP and transscapular films miss many lesions, so order the AP in 45 degrees internal rotation and the Stryker notch view.
The three-grade depth classification introduced here gives a simple way to describe the defect, which matters later when a large engaging Hill-Sachs affects surgical decision-making.
This prospective study used arthroscopy within 72 hours to look inside the shoulder after a first-time anterior dislocation. It asked how often a Hill-Sachs lesion is actually present after a single dislocation. All 32 patients were young military members or their families with no prior shoulder injury.
The key teaching point: a Hill-Sachs lesion is not proof of recurrent instability. It is present in nearly half of first-time dislocators. When you see a Hill-Sachs lesion on imaging after a single dislocation, do not over-read it as chronic disease. It is an expected impaction fracture from the posterolateral head hitting the glenoid rim.
The clinically important lesion driving instability is the accompanying Bankart tear, which coexisted in 87% here and cannot be seen on plain films. Diagnosis depends on getting the right views. Standard AP and transscapular films miss many lesions, so order the AP in 45 degrees internal rotation and the Stryker notch view.
The three-grade depth classification introduced here gives a simple way to describe the defect, which matters later when a large engaging Hill-Sachs affects surgical decision-making.